What is a Subdural Hematoma?

Subdural hematomas are collections of blood between the covering and the surface of the brain. Most often caused by severe head injuries, subdural hematomas can be dangerous as blood can fill the brain area rapidly, compressing brain tissue. Chronic subdural hematomas may occur in elderly people after minor head injuries and may go unnoticed for weeks.

Baptist Health is known for advanced, superior care in diagnosing and treating subdural hematomas. Our 24/7 inpatient neurology and neurosurgery services, as well as our outpatient and Home Health physical, occupational, cognitive and speech therapy services are available to help treat people with subdural hematomas. In addition, we have the region’s only advanced 3Tesla MRI, MRI spectroscopy and functional MRI, MRI angiography, CT angiography and conventional cerebral angiography technology to accurately diagnose all manner of neurologic disease, including subdural hematomas.

You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Types of Subdural Hematomas

There are several different types of subdural hematomas and they are classified by how fast they develop, how much they bleed, and how much damage the bleeding causes. The types of subdural hematomas include: 

Acute Subdural Hematoma

These hematomas are the most dangerous type. The symptoms often present immediately after the severe head injury and can be life-threatening. 

Subacute Subdural Hematoma

This type can take days to weeks after the head injury for symptoms to develop.

Chronic Subdural Hematoma

This type can cause slow bleeding in the brain and may take weeks or months for symptoms to develop. The head injuries tend to be less severe, but happen enough over time (i.e., bumping your head repeatedly when you get in the car) that it can cause a subdural hematoma. This type tends to affect older populations and those who are on blood thinners.

All three types require medical attention as soon as symptoms develop, which will help to prevent any permanent brain damage.

Signs and Symptoms

Subdural hematoma symptoms may include:

• Confused or slurred speech
• Confusion or changes in behavior
• Difficulty with balance or walking
• Dizziness
• Feeding difficulties (in infants)
• Headache
• Increased head circumference (in infants)
• Irritability (infants)
• Lethargy or extreme drowsiness
• Loss of consciousness
• Nausea and/or vomiting
• Numbness
• Seizures
• Visual disturbances
• Weakness

Diagnosis

To determine if someone has a subdural hematoma, we use advanced diagnostic procedures and technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures can include:

• Computerized tomography (CT) scan: This test uses X-rays and computers to create images of the skull and brain. Sometimes, a patient will be injected with contrast dye to make abnormalities easier to see.
• Magnetic resonance imaging (MRI): This test uses a powerful magnet and radio waves to produce images of the brain and check for the presence of a subdural hematoma.

Causes

Most subdural hematomas are caused by a head injury from:

• An accident
• Fall
• Blow to the head
• Other traumatic event

Risk Factors

Risk factors that may contribute to subdural hematomas include:

• Age: Very young and elderly people are most at risk for subdural hematomas.
• Anticoagulant medication: Taking blood thinners, including aspirin, raises the risk for an injury-induced subdural hematoma.
• Blood clotting problems: Certain medical conditions can cause blood to clot poorly and raise a person’s risk of subdural hematomas.
• Recurrent falls or repeated head injury: Repeated injury to the head increases the risk of subdural hematoma formation.

Prevention

You can help prevent subdural hematomas by taking these precautions:

• Wear safety equipment: Use hard hats, bike helmets and seat belts to reduce your risks of subdural hematoma at work, on the road or during home improvement projects.
• Prohibit falls: Be cautious, especially if you are elderly or disabled, of fall risks such as walking on wet floors, climbing ladders and getting in and out of the tub.
• Avoid alcohol: Long-term alcohol abuse can increase the risk that a subdural hematoma will develop after an injury.

Prognosis

A subdural hematoma's prognosis depends on the type and location of head injury and how quickly a person receives treatment. Acute subdural hematomas are more dangerous than the chronic type and, if not treated quickly, can be fatal.

Treatment

Treatment of subdural hematomas may include:

• Medication: Diuretics and corticosteroids may be prescribed to reduce swelling. Anti-convulsion medications, such as phenytoin, may be used to control or prevent seizures.

• Surgical Procedures: A person with a subdural hematoma may require emergency surgery to reduce pressure in the brain. The surgeon may drill a small hole in the skull to drain blood and reduce this pressure. A large hematoma or blood clot may need to be removed through a larger skull opening in a procedure known as a craniotomy.

Complications

Subdural hematomas can cause complications including:

• Brain herniation: A subdural hematoma can put severe pressure on the brain, leading to coma or even death if untreated.
• Ongoing symptoms: Anxiety, dizziness, headache, memory loss and problems concentrating may persist even after treatment.
• Seizures: Damage to the brain from subdural hematomas can lead to seizures. These can usually be controlled with proper treatment.

Recovery and Rehabilitation

Recovery and rehabilitation for subdural hematomas is different for each individual. Depending on the severity and damage from the subdural hematoma, recovery can take weeks to months, and some people may even have life-long complications from it.

Complications can range from changes in mood, issues with concentration and focus, memory problems, seizures, speech and language difficulties, and trouble with movement or weakness in limbs. There is also a risk that the hematoma could come back after surgery. This may make it necessary for a patient to have an additional surgery to drain it.

If a patient has extended complications from the hematoma or surgery, further support may be needed. Rehabilitation helps a person return to normal activities and is usually comprised of multiple types of healthcare professionals. There are several therapy options for rehabilitation, which include:

• Physiotherapy. Helps restore and correct issues with coordination, movement, and muscle weakness.
• Occupational therapy. Focuses on helping patients perform normal day to day tasks and activities again.
• Speech or language therapy. Focuses on helping patients to regain or improve speech or language issues.
• Psychological support or therapy. Seeks to resolve issues related to mood, emotional stability, behavioral issues, adjustment issues, or problems with focus and concentration.

It is important that recovery and rehabilitation happens at an appropriate pace, with ample time to rest and heal. The brain needs time to rest and recover, which may mean limiting time with electronics. Additionally, it is important to speak with your doctor before returning to a sport, driving, or flying.